Voluntary counseling and testing for couples: A high-leverage intervention for HIV/AIDS prevention in sub-Saharan Africa

Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention, Division of HIV/AIDS Prevention-Surveillance and Epidemiology, Atlanta, GA 30333, USA.
Social Science & Medicine (Impact Factor: 2.56). 01/2002; 53(11):1397-411. DOI: 10.1016/S0277-9536(00)00427-5
Source: PubMed

ABSTRACT Most HIV infections in sub-Saharan Africa occur during heterosexual intercourse between persons in couple relationships. Women who are infected by HIV seropositive partners risk infecting their infants in turn. Despite their salience as social contexts for sexual activity and HIV infection, couple relationships have not been given adequate attention by social/behavioral research in sub-Saharan Africa. Increasingly studies point to the value of voluntary HIV counseling and testing (VCT) as a HIV prevention tool. Studies in Africa frequently report that VCT is associated with reduced risk behaviors and lower rates of seroconversion among HIV serodiscordant couples. Many of these studies point out that VCT has considerable potential for HIV prevention among other heterosexual couples, and recommend that VCT for couples be practiced more widely in Africa. However, follow-up in the area of VCT for couples has been extremely limited. Thus, current understandings from social/behavioral research on how couples in sub-Saharan Africa manage HIV risks as well as HIV prevention interventions to support couples' HIV prevention efforts have remained underdeveloped. It appears that important opportunities are being missed for preventing HIV infection, be it by heterosexual transmission or mother-to-child HIV transmission by mothers who have been infected by their partners. Based on an overview of documentation on VCT in sub-Saharan Africa, this paper proposes that increased attention to couples-focused VCT provides a high-leverage HIV prevention intervention for African countries. The second half of the paper indicates areas where VCT needs to be strengthened, particularly with respect to couples. It also identifies areas where applied social/behavioral research is needed to improve knowledge about how couples in sub-Saharan Africa deal with the risks of HIV infection.

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Available from: Thomas M Painter, Aug 14, 2015
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    • "CVCT has been shown to be an efficacious HIV prevention strategy and findings suggest that it may be an appropriate and effective method for reducing transmission within male couples (Burton, Darbes, & Operario, 2010; El-Bassel et al., 2010). The World Health Organization (WHO) (2012) has issued guidance for implementing CVCT, which has been used effectively with heterosexual couples in Africa (Allen et al., 1992; Chomba et al., 2008; Farquhar et al., 2004; Guthrie, de Bruyn, & Farquhar, 2007; Painter, 2001), and findings suggest this is a promising strategy for prevention among MSM couples (Coates, 2000; Painter, 2001; Stephenson, Rentsch, & Sullivan, 2012a; Stephenson et al., 2011, 2012b). "
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    ABSTRACT: Main partnerships represent one context in which HIV transmission may occur that has been insufficiently addressed to date for gay and bisexual men, but few studies have focused on the acceptability of couples-based voluntary HIV counseling and testing (CVCT) for male couples in the U.S. Our aim in this study was to explore the acceptability of CVCT among a national U.S. sample of 1,532 gay and bisexual men surveyed online using a sexual networking site. We examined the role of demographic (i.e., geographic region, age, relationship status, sexual orientation, race/ethnicity) and HIV risk (i.e., substance use, number of sexual partners, unprotected anal intercourse, sexual role identity, and sexual compulsivity) factors that may be associated with CVCT among the full sample and among partnered men separately. We found that single men expressed higher interest in CVCT than partnered men and that greater age was more strongly associated with lower interest in CVCT for partnered men than for single men. The intersection of sexual orientation and race/ethnicity was also significantly associated with CVCT interest, with a higher proportion of Black bisexual men being interested than White bisexual men. These findings suggest that the uptake of CVCT may be less impacted by HIV risk factors than by demographic factors and that young gay and bisexual men of color-for whom rates of HIV continue to rise-may be the group with the highest levels of interest in CVCT.
    Archives of Sexual Behavior 11/2013; 43(1). DOI:10.1007/s10508-013-0226-6 · 3.53 Impact Factor
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    • "Joint couple or partner testing on the other hand appears to have stronger prevention benefits, especially in the case of discordant couples (Allen et al., 2003; Cohen et al., 2011). However, despite the apparent importance of couple testing for treatment and prevention purposes, there have been few successful experiences of HTC programs reaching couples (Padian et al., 1993; Painter, 2001). Furthermore, recent evidence on the effectiveness of ART for prevention of HIV transmission among couples makes this a key intervention of prevention programs in generalized epidemic countries (Dodd et al., 2010; El-Sadr et al., 2010; Wagner et al., 2010). "
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    ABSTRACT: This is a Policy Research Working Paper from the World Bank. Paying for performance provides financial rewards to medical care providers for improvements in performance measured by specific utilization and quality of care indicators. In 2006, Rwanda began a paying for performance scheme to improve health services delivery, including HIV/AIDS services. This study examines the scheme's impact on individual and couples HIV testing and counseling and using data from a prospective quasi-experimental design. The study finds a positive impact of paying for performance with an increase of 6.1 percentage points in the probability of individuals having ever been tested. This positive impact is stronger for married individuals: 10.2 percentage points. The results also indicate larger impacts of paying for performance on the likelihood that the respondent reports both partners have ever been tested, especially among discordant couples (14.7 percentage point increase) in which only one of the partners is HIV positive.
    Journal of Health Economics 02/2013; DOI:10.1016/j.jhealeco.2014.12.001 · 2.25 Impact Factor
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    • "In Ethiopia, access to individual VCT has increased rapidly, while couple VCT services have remained limited, despite high levels (85%) of serodiscordance among HIV affected cohabiting couples (Federal HIV/AIDS Prevention and Control Office Federal Democratic Republic of Ethiopia, 2008). In Africa, belonging to a stable heterosexual couple does not necessarily protect against HIV because of possible infidelity or prior infection of one of the partners (Desgrees- Du-Lou & Orne-Gliemann, 2008; Malamba et al., 2005; Painter, 2001). In fact, it is estimated that the majority of incident heterosexual HIV infections occur in serodiscordant cohabiting or married couples in urban Zambia and Rwanda (Dunkle et al., 2008). "
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    ABSTRACT: Studies show reduced HIV risk behaviors after couple voluntary counseling and testing (VCT), either resulting from the couple counseling process or the type of people it attracts. A total of 1858 sexually active individual VCT clients in partnerships were compared to 866 sexually experienced couple VCT participants with multilevel logistic regression. Sexually experienced couple VCT clients were also compared to those couple VCT clients who never had sex. Among sexually experienced participants in partnerships, women, non-premarital testers, and those who felt at risk for HIV were less likely to attend couple VCT than individual VCT. Among couple VCT clients, sexually inexperienced individuals were more likely to be: testing for the first time, premarital testers, and more educated than those who were sexually experienced. Couple VCT's effectiveness might partly result from who it attracts. Addressing the diverse needs of a heterogeneous testing population is a programmatic challenge for couple VCT in Ethiopia.
    AIDS Care 01/2012; 24(7). DOI:10.1080/09540121.2011.648601 · 1.60 Impact Factor
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